Cultural Competence in Anesthesia Care

Michael Conti, CRNA, MSN, PANA Vice President, Chair Wellness Committee.

Every one of us will be confronted with diversity in our patient population, especially those working in urban areas. The notion of "cultural competence" in health care delivery is not a recent phenomenon, but one that is gaining more attention in the literature areas.

Between 1990 and 2000, 33 million individuals immigrated to the United States, the majority of which were Hispanic and Asian. According to the recent United States literature, the US. has shifted from a "melting pot", where different cultures and races that were once assimilated, to a "mosaic" where different cultures and races are now unassimilated.

There are a multitude of other differences to consider as well depending on the geographic areas where one practices. Religious differences, gender/transgender, and social issues should be considered as well. One may question the issue of the "nuclear family" where children are being raised by single parents, grandparents and same sex couples.

According to a recent New York Times article, "Doctors Miss Cultural Needs" by

Kevin Sack (6/10/2006), the following findings were evident:

· Many physicians, we can extrapolate to include CRNA's, do not discriminate inthe way they counsel patients.

· A "one size fits all" approach may leave minority patients with unmet needs.

· The suggested data implicates that providers are not providing unequal care, but differences are spread throughout the entire health care system.

Since our interactions with patients are usually quite short and episodic, 5-10 minutes in the holding room or even in the OR in some facilities, we must engage the patient's trust in a very short period of time. Cultural incompetence or simply being unaware may lead to miscommunication, non-compliance, and lack of provider acceptance according to Broadmax in her book Transcultural Nursing. These three factors may lead to an adverse outcome during the course of a routine anesthetic. One example that comes to mind would be ginseng or St. John's Wort. Ginseng may lead to increased bleeding due hi platelet dysfunction and St John's Wort may cause a delayed emergence caused by a synergistic effect with volatile agents.

There are a few simple things we can do to maximize the patient's experience. Approach every patient with an open mind, don't make assumptions and employ your facilities translator service to ensure the patient has an adequate understanding, particularly when it comes to issues of consent. There may be some situations that potentially cause discomfort to the provider, such as issues of sexuality, orientation, and transgender issues. A student recently approached me and mentioned she had the opportunity to participate in an anesthetic for an individual undergoing male to female gender reassignment surgery (at a small community hospital no less). I asked her how she dealt with the situation. She stated she approached the patient very "matter of factly",

With an open mind and most importantly she didn't judge him/her.

In summary, anesthesia providers will encounter an increasingly diverse patient population as geographic, racial, societal, and religious climates shift. We need to be prepared to deliver safe, appropriate and patient specific care to these individuals.

(The following web address is a very humorous clip from You Tube, I had the opportunity to view at the Assembly of School Faculty in February. I hope you find it as enjoyable as I did. http://youtube.com/watch?v=Zdf2eLeCLHI)